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Results: 12

Interventions for idiopathic intracranial hypertension

Idiopathic intracranial hypertension is a condition in which there is increased pressure inside the head without any obvious cause. This generally results in swelling of the optic disc (the point where the optic nerve meets the eye). The swelling in turn causes a potential threat to sight. The condition occurs most commonly in young women who are obese. A number of treatments have been advocated. This review could not find enough evidence to indicate the best form of treatment. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

There is some evidence that human growth hormone may help reduce growth problems in children with chronic kidney disease

The kidneys filter blood. Children with chronic kidney disease (CKD) may progress to end‐stage kidney failure and need their blood filtered by machine (dialysis) or they need a kidney transplant. CKD can stunt growth in children. Growth hormone (rhGH) has been used to help children grow to a more average height for their age but rhGH may have adverse effects including added risk of transplant rejection and high pressure in the brain. This review of 16 studies enrolling 809 children found that rhGH increased height in children with CKD by about 4 cm after 1 year and by a further 2 cm after 2 years of treatment compared with no treatment. The frequency of reported side effects of rhGH was generally similar to that of the control group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Mannitol for acute traumatic brain injury

Mannitol is a sugar alcohol solution which is sometimes effective in reducing brain swelling after head injury. However, its effectiveness in the ongoing treatment of severe head injury remains unclear. There is evidence that excessive administration of mannitol may be harmful, by mannitol passing from the bloodstream into the brain, where it increases pressure within the skull and worsens brain swelling. The review authors searched the medical literature and identified four randomized controlled trials comparing mannitol to other treatment strategies for reducing brain swelling after head injury. One trial compared treatment with mannitol directed by measurement of the pressure within the skull (intracranial pressure) with ‘standard treatment’ (treatment without measurement of intracranial pressure). One trial compared treatment with mannitol to treatment with pentobarbital (a barbiturate drug). One trial compared treatment with mannitol to treatment with hypertonic saline (highly concentrated salt solution). One trial compared treatment with mannitol to treatment with placebo (an inactive ‘dummy’ solution) before arrival in the hospital (pre‐hospital). The review found that treatment with mannitol for increased intracranial pressure reduced the likelihood of death when compared to treatment with pentobarbital. In contrast, it found that treatment with mannitol may increase the likelihood of death when compared to treatment with hypertonic saline. The review also found a small benefit when mannitol treatment is directed by measurement of intracranial pressure compared to ‘standard treatment.’ The review found insufficient data on the effectiveness of pre‐hospital administration of mannitol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Inhaled nitric oxide for respiratory failure in preterm infants

The use of inhaled nitric oxide (iNO) may help reduce breathing failure in preterm babies. Breathing failure in premature newborn babies may be complicated by raised pressure within the vessels that carry blood to the lung (pulmonary hypertension). Medications that cause sedation or muscle relaxation and mechanically assisted breathing (mechanical or assisted ventilation) are used to treat pulmonary hypertension. Nitric oxide is believed to help regulate muscle tone in the arteries of the lungs and, thereby lessen pulmonary hypertension; however, iNO may also cause excessive bleeding (hemorrhage). This review of studies found that nitric oxide therapy does not appear to improve the chances of the baby having an improved outcome. When given to babies who were very ill, iNO did not seem to help, and may have contributed to an increase in intracranial hemorrhage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Comparison of two muscle relaxants, rocuronium and succinylcholine, to facilitate rapid sequence induction intubation

In emergency situations some patients need a general anaesthetic with an endotracheal tube (tube to help them breathe). It is important to have fast acting medications to allow physicians to complete this procedure quickly and safely. Currently, the muscle relaxant medication most often used to accomplish this is succinylcholine. Succinylcholine is fast acting and lasts for only a few minutes which is very desirable in this setting. However, some patients cannot use this medication as it can cause serious salt imbalances or reactions, so an equally effective medication without these side effects is desired. This meta‐analysis compared one possible alternative, rocuronium, for the quality of intubation conditions (the ease with which physicians can quickly and safely pass the endotracheal tube). In this review, we have combined the results of 37 studies, with a total of 2690 patients, which compared the effects of succinylcholine versus rocuronium on intubation conditions. We have found that rocuronium is less effective than succinylcholine for creating excellent intubation conditions. Rocuronium should therefore only be used as an alternative to succinylcholine when it is known that succinylcholine should not be used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Barbiturate drugs for people with traumatic brain injury

An injury to the head can lead to the brain swelling from leaking blood or from clotting, or an imbalance in fluid around the brain. As space inside the skull is limited, this can cause dangerous levels of pressure on the brain (raised intracranial pressure − ICP). Barbiturates are sedatives that are commonly used to treat ICP. They slow down brain action and this can reduce the production of fluid.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is a major complication of premature birth and a cause of cerebral palsy and hydrocephalus. Repeated early lumbar puncture or ventricular taps have been advocated as a way of avoiding hydrocephalus and protecting the brain from pressure. It was thought that the risk of hydrocephalus and the need for a ventriculoperitoneal shunt might be reduced by the removal of protein and old blood in the cerebrospinal fluid. This hypothesis has been tested in four randomised trials involving premature infants in whom IVH (with or without established enlargement) was diagnosed by ultrasound. There is no evidence that early tapping of cerebrospinal fluid by lumbar puncture or ventricular tap reduces the risk of shunt dependence, disability, multiple disability or death. The use of repeated taps was associated with an increased risk of central nervous system infection. Thus the early use of early tapping cannot be recommended. Removing cerebrospinal fluid should be reserved for cases where there is symptomatic raised intracranial pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Does hyperbaric oxygen therapy improve the survival and quality of life in patients with traumatic brain injury?

Traumatic brain injury is a major cause of death and disability. Not all damage to the brain occurs at the moment of injury; a reduction of the blood flow and oxygen supply to the brain can occur afterwards and cause further secondary brain damage that is itself an important cause of avoidable death and disability. In the early stages after injury, it is therefore important that efforts are made to minimise secondary brain damage to provide the best chances of recovery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource‐limited settings

Despite the advent and increasingly wide availability of antiretroviral therapy for people with HIV/AIDS, cryptococcal meningitis remains a significant cause of death and illness amongst individuals with HIV infection in resource‐limited settings (poor countries). The ideal way to manage cryptococcal meningitis remains unclear. The main aim of this review was to determine the best treatment for cryptococcal meningitis in resource‐limited settings. In these settings, usually only Amphotericin and fluconazole are available. The authors didn't find any suitable studies that compared these two drugs. Because Flucytosine, which works well with Amphotericin, is often not available in poor countries, policy makers and government officials should consider using this drug for HIV treatment programmes. Future research into the management of cryptococcal meningitis in resource‐limited settings should focus on the most effective use of medications that are available in these settings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The role of chemotherapy additional to high‐dose methotrexate for treatment of patients with primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is a malignant disease of the lymphatic system that accounts for about 2% to 5% of all primary intracranial tumours in immunocompetent patients. It is a form of extranodal non‐Hodgkin lymphoma (NHL) and appears at a median age of 62 years. PCNSL is a rare disease with an incidence of 2.7 cases per million population per year, but since the 1990s the occurrence of it has increased in immunocompetent as well as immunocompromised (mostly human immunodeficiency virus (HIV)‐infection related) populations. Symptoms of PCNSL can present manifold though the usual signs are neurological deficits, neuropsychiatric symptoms and raised intracranial pressure. Despite improved treatment strategies, overall survival is still poor and a standard of care for PCNSL patients has not been defined yet. However, high‐dose methotrexate (HD‐MTX) with additional chemotherapy is considered to increase overall survival although the value of additional chemotherapy remains unclear, as there is evidence of a higher risk of adverse events. In this systematic review we summarised and analysed the evidence from randomised controlled trials (RCTs) on efficacy and safety of methotrexate combined with additional chemotherapy in the treatment of adult, immunocompetent PCNSL patients regarding overall survival, progression‐free survival, response rate, adverse events, treatment‐related mortality and quality of life. We searched several important medical databases such as CENTRAL and MEDLINE and found one RCT with 79 patients that fulfilled our inclusion criteria. As a result, this review shows that patients treated with methotrexate plus cytarabine compared to high‐dose methotrexate alone have a statistically significant improvement in progression‐free survival and response rate. No statistically significant difference is shown for overall survival. Adverse events, especially infections, hepatotoxicity and haematological toxicities are more common in patients undergoing therapy with methotrexate plus cytarabine, although there are no differences in terms of treatment‐related mortality. Owing to the small number of included trials and patients, the findings in this review remain uncertain and more RCTs with enlarged numbers of patients and longer follow‐up periods are needed. However, the one analysed study demonstrated that RCTs are feasible on patients with this rare disease and should concentrate on overall survival.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Vitamin A supplementation to prevent mortality and short‐ and long‐term morbidity in very low birthweight infants

Vitamin A is a group of fat‐soluble compounds used by the body for regulation and promotion of growth and differentiation of many cells, including cells in the retina of the eye and the cells that line the lung. Preterm infants have low vitamin A levels at birth. This may contribute to an increased risk of developing chronic lung disease, and hence a requirement for oxygen. It is possible that additional vitamin A supplement may reduce complications of prematurity, including abnormal development of the retina (retinopathy), bleeding in the brain (intraventricular haemorrhage), and damage to the gut from inflammation (necrotising enterocolitis) as well as reducing respiratory infections. Too much vitamin A is potentially harmful as it can raise intracranial pressure and cause skin and mucous membrane changes (injury or lesions), and vomiting. Nine trials were included in this review, eight comparing vitamin A with a control (placebo or no supplementation) and one comparing different vitamin A regimens. Supplementing very low birthweight infants with vitamin A by intramuscular injection or in the milk formula was associated with a trend toward a reduced number of deaths or oxygen requirement at one month of age compared to placebo. For surviving infants with birthweight less than 1000 g (three trials, 824 infants of which at least 96% had a birthweight < 1000 g), fewer infants required oxygen at 36 weeks' postmenstrual age compared to the control; the number needed to treat for one to benefit was 13 (95% confidence interval 7 to 100). Three trials with information on retinopathy of prematurity suggested a trend towards reduced incidence in infants receiving vitamin A supplementation. The one trial that investigated neurodevelopmental status at 18 to 22 months of age correcting for prematurity found no evidence of benefit or harm associated with vitamin A supplementation compared to control. No adverse effects of vitamin A supplementation were reported, but it was noted that intramuscular injections of vitamin A were painful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Thrombolysis for acute ischaemic stroke

Thrombolytic therapy is one of the most promising treatments for acute ischaemic stroke. The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with clot dissolving (thrombolytic) drugs can restore blood flow before major brain damage has occurred. Successful treatment could mean the patient is more likely to make a good recovery from their stroke. Thrombolytic drugs can also, however, cause serious bleeding in the brain, which can be fatal. Thrombolytic therapy has now been evaluated in several randomised trials in acute ischaemic stroke. The thrombolytic drug alteplase (rt‐PA) has been licensed for use within three hours of stroke in the USA, Canada, and most European countries but only few patients receive the treatment. This review of 26 trials involving 7152 patients confirmed that thrombolytic treatment can reduce the risk of disability, despite the bleeding risks. However, there was not enough evidence to answer several questions. How big is the overall benefit? What is the latest time window in which the treatment is still beneficial? Which grades of stroke severity and which types of stroke, as judged clinically and on brain imaging, are more likely to respond favourably to treatment? Should patients aged over 80 years receive thrombolysis? Which types of patients are most likely to be harmed by, and which to benefit from, treatment (e.g. with or without other major medical conditions like cardiac arrhythmias, diabetes, hypertension, or other disorders and concomitant medication)? To answer these questions reliably, and in particular to be able to tailor treatment to the individual patient, more data are needed from new randomised controlled trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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